This project addresses concerns that the introduction and use of new medical technology may contribute to rising health care costs. The project focuses specifically on the use of electronic fetal monitoring in intrapartum management of the obstetrical patient. Questions regarding the appropriate utilization of fetal monitoring will be addressed through the development of a clinical decision-making model. Based on existing knowledge of the efficacy, safety and costs of monitoring, the model will display all major decisions and clinical events leading to preinatal and maternal outcomes. A sample of obstetricians will be interviewed to provide data on probabilities and preferences (utilities) associated with the identified events and outcomes. Decision analysis will be employed to aid obstetricians in selecting among alternative monitoring practices. Implications which adoption of these monitoring practices may have for society will be assessed through cost-effectiveness analysis. To assure confidence in the project's analytic findings, sensitivity analysis of the major parameters and assumptions will be performed. The project will also explore policy issues relevant to fetal monitoring, and will develop strategies for implementing public policy options. Attention will be directed toward cost containment mechanisms in particular. Finally, the project will assess policies which govern the development, diffusion and utilization of new medical technology.